Download Treating High Cholesterol

Treating High Cholesterol
A Guide for Adults
Fast Facts
n
High cholesterol can lead to heart attacks and strokes.
n
There are different kinds of medicines to treat high cholesterol.
n
Medicines called statins are used the most.
n
If your cholesterol is still too high when you are taking a statin,
there are options. Your doctor or nurse can increase your statin
dose or add a different kind of cholesterol medicine.
n
Research can’t tell us yet if taking a statin and another kind of
cholesterol medicine lowers cholesterol more than taking only a
statin.
n
Research also can’t tell us yet if taking a statin and another kind of
cholesterol medicine helps prevent more heart attacks or strokes
than taking only a statin.
Inside
Learning About Cholesterol..................................................................2
Setting Your Cholesterol Goal ..............................................................4
How Is High Cholesterol Treated? ......................................................5
Learning About Cholesterol Medicines ..............................................6
Are Two Medicines Better Than One? ................................................8
Side Effects of Cholesterol Medicines..................................................8
Talking With Your Doctor About High Cholesterol..........................9
Track Your Cholesterol Levels ............................................................10
Track Your Cholesterol Medicines ....................................................11
For More Information..........................................................................12
What Does This Guide Cover?
Keeping your cholesterol at a good level can help lower your chance
of heart attacks and strokes. This guide can help you talk with your
doctor or nurse about medicines to treat high cholesterol. It covers:
n
Different kinds of cholesterol medicines.
n
How the medicines work.
n
Side effects of cholesterol medicines.
n
The information in this guide comes from a government-funded
review of research about cholesterol medicines.
What Is Not Covered in This Guide?
This guide does not compare all the ways to lower cholesterol. It does
not compare cholesterol medicines with herbal treatments or dietary
treatments (like oatmeal). It also does not compare all the
combinations of medicines. This guide does not cover the treatment
of high cholesterol in people under 18 years old.
Learning About Cholesterol
Cholesterol is a building block of our body’s cells. The liver makes
cholesterol. Cholesterol travels to the body’s cells in the blood. We all
need some cholesterol, but our bodies can make all the cholesterol we
need. Certain foods are an added source of cholesterol.
Many people have the right amount of cholesterol. Other people have
too much. High cholesterol sometimes runs in families.
There are different types of cholesterol. The two main types are often
called “bad” and “good.” The bad cholesterol can damage the heart
and arteries, but good cholesterol does not cause damage.
Bad Cholesterol (LDL Cholesterol)
Everyone should try to keep bad (LDL) cholesterol as low as possible.
If your doctor or nurse tells you that you have high cholesterol, it
means that your bad cholesterol is too high.
When you have too much bad (LDL) cholesterol in your blood, it can
build up on the walls of
your arteries. This buildup is called plaque
Normal Artery
Artery
(pronounced “plak”).
wall
Plaque can narrow your
arteries and make it
Normal
harder for blood to flow.
blood flow
Plaque can lead to heart
Abnormal
attacks and strokes.
Artery cross-section
Narrowed blood flow
Plaque
Artery
Keeping bad cholesterol
at a low level can help
avoid these problems.
Used with permission from the National
Heart, Lung, and Blood Institute of the
National Institutes of Health.
2
Narrowed Plaque
artery
Good Cholesterol (HDL Cholesterol)
Good (HDL) cholesterol helps remove extra cholesterol from the
body. When your good cholesterol is higher, your chance of heart
disease is lower. If your good cholesterol is 60 or higher, that helps
protect against heart attacks and strokes.
Triglycerides
Triglycerides (try-GLIS-uh-rides) are a kind of fat found in your
blood. The body makes triglycerides. They are also found in food.
Your body needs this kind of fat, but it’s best to keep your
triglycerides low. Less than 150 is usually the goal.
Just having high cholesterol does not cause any symptoms. Most
people do not know they have high cholesterol unless they get
tested. Having a blood test to check your cholesterol will tell you
if your levels are on target.
Checking Your Cholesterol Levels
Cholesterol is measured by a blood test done at your doctor’s office
or a lab. A cholesterol test will tell you your total cholesterol level. It
will also tell you the levels of your good (HDL) and bad (LDL)
cholesterol and your triglycerides.
How often you have this blood test may depend on your personal
risk for heart attacks or strokes. Talk to your doctor or nurse about
how often your cholesterol should be checked.
3
Setting Your Cholesterol Goal
The target for your bad (LDL) cholesterol depends on your risk
factors for heart disease. Risk factors are things that increase your
chance of having a heart attack or stroke. If you have more risk
factors, your doctor or nurse will recommend a lower target for your
bad cholesterol. Talk with your doctor or nurse about setting your
cholesterol goal.
Risk Factors
These are some risk factors for heart disease.
n
Age.
• For men—being 45 or older.
• For women—being 55 or older.
n
Family history of early heart disease.
n
Smoking.
n
High blood pressure.
n
Low levels of good (HDL) cholesterol.
People at Moderate Risk
People with two or more risk factors (listed above) are at moderate
risk for heart attacks and strokes.
People at High Risk
People who already have heart disease or diabetes are at high risk for
heart attacks and strokes. Others with certain risk combinations also
fall into this group. Ask your doctor or nurse whether you fall into
this high-risk group.
4
How Is High Cholesterol Treated?
The first step in controlling your cholesterol is to eat a balanced diet
and to be more active. Even small changes can make a big difference.
Your doctor or nurse may recommend a special cholesterol-lowering
diet. The cholesterol-lowering diet follows simple guidelines like:
n
Eating a variety of foods, including fresh fruits, vegetables, and
whole grains.
n
Limiting fat calories to 35 percent or less of total calories eaten
each day.
n
Limiting foods with cholesterol in them, like egg yolks.
n
Eating foods with fiber in them, like whole grains.
Some people can reach their cholesterol goals by eating a balanced
diet and exercising. But many people will also need medicine to
lower their cholesterol.
5
Learning About Cholesterol Medicines
Different kinds of cholesterol medicines work in different ways to
improve your cholesterol levels. Some medicines can lower your
triglycerides. Most people start with a statin because statins usually
work well to lower bad (LDL) cholesterol. If your bad cholesterol is
still too high, your doctor or nurse may increase your statin dose or
add a different kind of cholesterol medicine to help you reach your
goal. This chart shows the different kinds of cholesterol medicines
and how they work.
6
Kinds of Cholesterol Medicines and How They Work
Generic Name
Brand Name
How They Work
Atorvastatin
Fluvastatin
Lipitor®
Lescol®
Block the liver from
making cholesterol.
Lovastatin
Mevacor®, Altoprev®
Pravastatin
Pravachol®
Rosuvastatin
Crestor®
Simvastatin
Zocor®
Statins
Bile Acid Binders
Cholestyramine
Colesevelam
Questran®
Welchol®
Colestipol
Colestid®
Decrease the amount of fat
absorbed from food.
Cholesterol Absorption Inhibitor
Ezetimibe
Zetia®
Decreases the amount of
cholesterol absorbed from
food. Also lowers
triglycerides.
Gemfibrozil
Lopid®
Help the liver break down
bad (LDL) cholesterol.
Also lower triglycerides.
Fenofibrate
TriCor®, Lofibra®
Fibrates
Vitamins and Supplements
Niacin
Niacor®, Niaspan®
Blocks the liver from
removing good (HDL)
cholesterol. Also lowers
triglycerides.
Omega-3 fatty acids
Lovaza®
Increase the level of good
(HDL) cholesterol. Also
lower triglycerides.
7
Are Two Medicines Better Than One?
Preventing Heart Attacks and Strokes
Research can’t tell us yet if taking a statin and another kind of
cholesterol medicine helps prevent more heart attacks or strokes than
taking only a statin. This is because most of the research didn’t
include very many people or last very long.
Lowering Cholesterol
Research can’t tell us yet if taking a statin and another kind of
cholesterol medicine lowers cholesterol more than taking only a
statin. This is because the research studies did not all measure
cholesterol in the same way. Some measured total cholesterol; some
only measured bad (LDL) or good (HDL) cholesterol.
Side Effects of Cholesterol Medicines
Minor Side Effects
All the medicines in this guide can cause minor side effects, like
heartburn, upset stomach, and diarrhea. These problems often go
away and are not usually serious. Tell your doctor or nurse if these
symptoms are severe or do not go away.
Serious Side Effects
Muscle problems
It is rare, but some cholesterol medicines can cause muscle damage.
If you are taking a cholesterol medicine and get muscle aches, tell
your doctor or nurse right away.
Liver problems
It is rare, but some cholesterol medicines can cause liver damage. You
might need a blood test to check your liver before you start these
medicines.
8
Research can’t tell us yet if combining cholesterol medicines leads
to more or fewer side effects than taking only a statin.
Talking With Your Doctor About High Cholesterol
Can I control my cholesterol by eating healthy and being
active?
Everyone with high cholesterol should be on a cholesterol-lowering
diet. Exercising can help too. If you can’t get to your cholesterol goal
with diet and exercise alone, you may need to start a cholesterol
medicine. Work with your doctor or nurse to set up a plan that works
for you.
Are all these medicines taken the same way?
Most cholesterol medicines are pills. A few come as powders that you
mix into a drink. Some are taken once a day. Others need to be taken
more often. With some combinations, the medicines can’t be taken at
the same time. Talk with your doctor or nurse about what kind of
schedule will be easiest for you to follow.
What about the cost?
Some medicines are available as generics, which cost less. If
prescriptions are part of your health insurance plan, ask about the
cost to you. If you need help paying for cholesterol medicines, there
may be a program for you. Contact the Partnership for Prescription
Assistance. Web site: pparx.org. Phone: 888-477-2669.
9
What else can I do to keep my heart healthy?
Lowering your cholesterol is an important step. But it’s also
important to control other health problems that can put you at risk
for heart attacks and stroke, like diabetes and high blood pressure.
Stopping smoking is important too.
If I lower my cholesterol enough with medicine, can I stop
taking the medicine?
Most people have to continue taking the medicine in order to keep
their cholesterol low. Cholesterol medicines are usually safe no
matter how long you have to take them.
Track Your Cholesterol Levels
Use this table to track your cholesterol levels. Each time you have
your cholesterol checked, fill in a row of the table. That way, you and
your doctor or nurse will be able to see how your levels change over
time.
My Cholesterol Levels
Date
10
Total
cholesterol
Good (HDL)
cholesterol
Bad (LDL)
cholesterol
Triglycerides
Track Your Cholesterol Medicines
Use this table to keep a record of the cholesterol medicines you take.
It will help you keep track of the medicines that work best for you.
My Cholesterol Medicines
Medicine
Dose
When did I start
taking this
medicine?
If I am no longer
taking it, why
did I stop?
11
For More Information
Visit www.effectivehealthcare.ahrq.gov.
Click on Guides for Patients and Consumers to print a copy of this
guide and learn about other conditions.
For free print copies of this guide, call 800-358-9295. Ask the
Publications Clearinghouse for AHRQ Publication Number
09(10)-EHC024-A.
To learn more about cholesterol, visit
www.nlm.nih.gov/medlineplus/cholesterol.html.
12
Source
The information in this guide comes from a detailed review of 102
research reports. The review is called Comparative Effectiveness of
Lipid-Modifying Agents (2009), and was written by the Johns Hopkins
Evidence-based Practice Center.
The Agency for Healthcare Research and Quality (AHRQ) created
the Eisenberg Center at Oregon Health & Science University to make
research helpful for consumers. This guide was written by Bruin
Rugge, M.D., Martha Schechtel, R.N., Rachelle Nicolai, B.A., Susan
Severance, M.P.H., and David Hickam, M.D., of the Eisenberg
Center. People with high cholesterol helped them develop this guide.
AHRQ Pub. No. 09(10)-EHC024-A
November 2009